| NPI | 1790704633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2009-01761) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL29193) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 141167) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-04-26 |